Healthcare Provider Details

I. General information

NPI: 1407549348
Provider Name (Legal Business Name): KEZIAH LIJI ABRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W MEDICAL CENTER BLVD STE 1700
WEBSTER TX
77598-4080
US

IV. Provider business mailing address

950 E SOUTHLAKE HWY 114 SUITE 200
SOUTHLAKE TX
76092
US

V. Phone/Fax

Practice location:
  • Phone: 281-480-6264
  • Fax:
Mailing address:
  • Phone: 214-424-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20166
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: